Basic Information
| Provider Information | |||||||||
| NPI: | 1952822942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELRAY MAUGHAN, M.D. PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13900 W WAINWRIGHT DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837135028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089385823 | ||||||||
| FaxNumber: | 2099385306 | ||||||||
| Practice Location | |||||||||
| Address1: | 13900 W WAINWRIGHT DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837135028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089385823 | ||||||||
| FaxNumber: | 2089385306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 08/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAUGHAN | ||||||||
| AuthorizedOfficialFirstName: | DELRAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2089385823 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | M-4908 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.